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How to Follow the Mediterranean Diet

The health benefits

The typical Western diet is high in animal fats and preservatives, but low in fruit and vegetables. Decades of high-quality scientific research have shown this food combination is partially responsible for triggering many chronic diseases and cancers currently prevalent in the UK and other industrialised nations.

Research has also shown that following a Mediterranean diet can drastically reduce the chance of developing conditions such as heart disease, type 2 diabetes, high blood pressure, obesity and even Alzheimer’s disease. (See separate leaflet called ‘Health Benefits of the Mediterranean Diet’ and Note 1.)

So, switching from a Western to a Mediterranean diet represents a healthy lifestyle choice. It can reduce the risk of a premature death and increase the chance of a healthy retirement, free from long-term medication. And, unlike long-term medication, the Mediterranean Diet has no known damaging side-effects.

The Mediterranean Diet

The term ‘Mediterranean Diet’ describes a specific mix of dietary food ingredients, shown, through extensive study, to promote health and longevity in people from many countries including the UK and USA.

The word ‘Mediterranean’ refers to the origins of the diet, rather than any requirement for those observing it to eat Greek or Italian foods (see Note 2) – although, such culinary experimentation can be extremely enjoyable and rewarding.

When planning ingredients for Mediterranean-style meals, it is worthwhile including lots of variety. For example, using a range of fruit and vegetables gives the body maximum access to sources of vitamins, minerals and other trace nutrients. And this is quite logical, when you realise that it’s only in recent times that supermarkets have been able to make the same foods available throughout the year, counteracting natural seasonal variety in the human diet.

The over-use of salt in flavouring Western-style meals and fast foods has been linked with increased blood pressure. The healthy alternative is to replace the excess salt with herbs, as Mediterranean folk have done for millennia. This can also add magical new flavours to quite simple pasta and rice dishes and stews.

General principles

The Mediterranean Diet is not about quick fix ‘superfoods’, beloved of food writers. Nor is it a strict list of prohibitions preventing occasional excess. Rather, the Mediterranean Diet is a formula for healthy day-to-day eating over the long term. Here’s a quick guide for those who’d like to dip their toes into the warm, blue waters of a Mediterranean diet:

  • Maximize your intake of vegetables, legumes, fruits and whole grain cereals.
  • Limit your red meat intake – fish and poultry are healthy substitutes.
  • Where possible, use mono-unsaturated olive oil or rapeseed oil in place of animal fat such as butter or lard.
  • Limit your intake of highly processed ‘fast foods’ and ‘ready meals’, where you cannot tell saturated fat and salt intake.
  • Eat no more than moderate amounts of dairy products, and preferably low-fat ones.
  • Do not add salt to your food at the table – there is already plenty there.
  • Snack on fruit, dried fruit and unsalted nuts rather than cakes, crisps and biscuits.
  • Drink (red) wine during meals, but no more than three small glasses per day if you are a man and no more than two small glasses per day if you are a woman.
  • Water is the best ‘non-alcoholic beverage’ (as opposed to sugary drinks), although health benefits have also been claimed for various teas and coffee (see Note 3).

Mediterranean Diet ingredients

Now, let’s consider what sorts of food we need to eat to follow a Mediterranean diet. The World Health Organization (WHO) – and the UK Government’s Change4Life campaign – recommend we eat five portions of fruit and vegetables a day. This guidance is partly based on, and entirely consistent with, research into components of the Mediterranean Diet (see Note 4).

Health-promoting food types to be encouraged

The following contain essential nutrients and have health-promoting properties.

Vegetables and Fruits
Examples Vegetables: onions, cabbage, courgettes, cucumbers, carrots, spinach, leeks, broccoli, asparagus, lettuce, cauliflower, aubergine, garlic and peppers.
Fruit: oranges, grapes, apples, bananas, pears, melons, plums, cherries, pineapples, olives, figs – and, perhaps surprisingly, tomatoes.
Also Tinned vegetables and fruit, vegetable soups and juices, dried fruit, fruit juice. Potatoes, often thought of as vegetables, are discussed separately below.
Analysis High in fibre, anti-oxidants and vitamin C.
Benefits Help reduce risk of heart and vascular disease, cancers and bowel problems.
Risk in Excess None known.
Cereals – wholemeal where possible
Examples Wheat, barley, oats, millet, corn and brown rice.
Also Found in cereal flakes, muesli, porridge, wholemeal pasta, wholemeal bread, spaghetti, couscous, polenta, crispbread, biscuits.
Analysis Proteins, carbohydrate, fibre, vitamins, minerals, anti-inflammatory agents.
Benefits Associated with decreased bowel problems, including cancers, lowered ‘bad’ blood fat and decreased heart disease.
Risk in Excess None known (some people are intolerant to gluten).
Legumes (grow in pods)
Examples Peas, beans, lentils, chickpeas, peanuts (they’re not really nuts).
Also Representatives from this versatile group can be spotted piled on plates (humble baked beans or peas), as bases for tasty soups and stews (eg lentils) or in Mediterranean-style dips (eg houmous).
Analysis Protein, carbohydrate, fibre, vitamin B, vitamin C.
Benefits Associated with reduced risk of heart and vascular disease.
Risk in Excess None known.
White and Oily Fish (and Seafood)
Examples White fish and shellfish: sole, cod, plaice, haddock, hake, halibut, sea bass, turbot, whiting, mullet, tinned tuna, squid, mussels, prawns, crab, lobster.
Whole fish: whitebait, sardines, pilchards, anchovy.
Oily fish: salmon, mackerel, herring, trout, fresh tuna.
Also Fish liver oil.
Analysis Protein, essential vitamins, minerals. Oily fish (and some shellfish) contain cardio-protective omega 3 fatty acids, vitamins A and D. Whole fish are a source of calcium and phosphorus. Shellfish are also good sources of trace minerals.
Benefits A mix of oily and white fish in the diet is an alternative source of protein that reduces the risk of heart disease and heartbeat irregularities.
Risk in Excess Some oily fish contains low levels of pollutants. Pregnant women and those trying for a baby should limit intake of certain types of fish (see Food Standards Agency website – reference below).

Beneficial food types, to be carefully measured

The following Mediterranean Diet components contain essential nutrients and have health-promoting properties. However, there are known health risks if consumed in excess.

When cooking Mediterranean-style meals, unsaturated oils are used to replace saturated animal fats, such as butter and lard (see Note 5). If you smother your healthy vegetables with a cream- or cheese-based sauce, then you’ll be adding saturated fat – so, how about cutting back on the saturated fat by using a smaller amount of a stronger cheese? Vegetables roasted with small amounts of olive oil are delicious. Why not clean the plate with unbuttered, tasty, wholemeal bread?

Many ‘fast foods’ are designed to tempt the palate, but contain high levels of unhealthy saturated fat, trans-fat (heat-degraded fat) and salt.

Overall, although typical Western and Mediterranean diets can have a similar total fat content, the Mediterranean Diet is high in health-protective mono-unsaturated fat, whilst being low in artery-clogging saturated and trans-fat (See Note 6).

Mono-unsaturated Oils (Fats)
Examples Olive oil (the traditional Mediterranean oil) and rapeseed oil (made in the UK).
Also Found in olives, nuts and seeds, avocados.
Analysis High in mono-unsaturated fat, low in saturated fat, high in calories (kcal). Also contain essential fatty acids and assist with vitamin absorption. Types of fat found in oils are normally listed on the back of the bottle. These oils are quite stable and don’t degrade into toxic components when heated.
Benefits Help protect against heart disease, some cancers (eg breast) and assist in lowering blood pressure.
Risk in Excess Mainly through risk of obesity due to high energy content.
Lean White Meat
Examples Chicken, turkey and other poultry.
Also Chicken fast food, turkey burgers, processed pies – generally high in animal fat and therefore not counting as lean white meat.
Analysis Lean white meat without skin is high in protein, vitamins (including vitamin B12) and minerals, but with much less saturated animal fat than red meat.
Benefits Contains essential nutrients.
Risk in Excess Mainly from ingesting too much saturated fat.
Nuts and Seeds
Examples Nuts: almonds, chestnuts, walnuts, cashew nuts, Brazil nuts.
Seeds: pumpkin, sunflower, sesame, poppy.
Also Found in muesli, seeds on breads, on cakes, etc.
Analysis Protein, fibre, vitamins and minerals. Nuts are high in ‘good’ unsaturated fats.
Benefits Help protect against heart disease, type 2 diabetes and reducing ‘bad’ blood cholesterol. Nuts possibly help body mechanisms control weight.
Risk in Excess Are high in energy and therefore traditionally thought to be associated with weight gain in excess. Avoid salted nuts – high salt intake is associated with high blood pressure. People with nut allergy should avoid nuts.
A tip Try having dried fruit, unsalted nuts or seeds as a snack in place of cream cakes, doughnuts or chocolate biscuits.
Wine – particularly Red Wine
Examples A huge range of red wines is available. Each prepared by fermentation of juice extracted from one or more varieties of grape.
Also Used in cooking.
Analysis Alcohol, anti-oxidants and anti-inflammatory chemicals. High in calories.
Benefits In small, regular amounts it can help protect against heart disease. Appears to have added effect if drunk with Mediterranean-style meals.
Risk in Excess Regularly exceeding recommended limits (three units per day for men and two units per day for women) increases the risk of addiction, cirrhosis, heart disease and cancer, eg breast. Pregnant women should not drink any alcohol.

Restricted foods

The following foods contain essential nutrients, but also carry significant health risks if consumed in excess.

Eggs
Examples Hens’ eggs, ducks’ eggs, quails’ eggs …
Also Extensively used in sauces, baking, omelettes, tarts, quiches, pancakes, mayonnaise, custard, pasta …
Analysis Protein, iodine, essential vitamins (B2, A, D) and minerals. They are also high in cholesterol.
Benefits Essential nutrients.
Risks in Excess Associated with an increased risk of type 2 diabetes. Potential heart and vascular disease risk.
Milk and Dairy Produce
Examples Milk, yoghurt, cheese, butter, cream, fromage frais.
Also Sauces, desserts, creamy curries, etc.
Analysis High in protein, vitamin A, vitamin B12 and calcium. Dairy products can also be high in ‘bad’ animal fats. Cream and butter are particularly high in fat. Cottage cheese, mozzarella and feta are some of the lower saturated fat cheeses. Ricotta is a high-fat cheese. Semi-skimmed milk is lower in fat than full-cream milk. Some products have added salt.
Benefits Calcium is needed for strong bones.
Risk in Excess Increased risk of heart and vascular disease, and raised ‘bad’ blood cholesterol due to the saturated fat content.
A tip Full-cream milk is rich in calcium, but also in saturated fat. Selecting semi-skimmed milk, low-fat yoghurts and lower-fat cheeses can help reduce bad unhealthy fat intake. Cottage cheese, mozzarella and feta are some of the lower saturated fat cheeses. Ricotta is a high-fat cheese (see Note 3).
Red Meat
Examples Beef, pork, lamb.
Also Found as mince and processed in pies, sausages and fast food.
Analysis High in protein, vitamins (including vitamin B12) and minerals (eg iron). Generally high in saturated animal fat. Lean cuts contain less fat.
Benefits Contains essential nutrients. But these can also be obtained from white meat, fish and vegetables.
Risk in excess Increased risk of cardiovascular disease and raised ‘bad’ blood cholesterol.
A tip One way of reducing red meat intake is to save it for special treats, eg Sunday roast. Alternatively, portions of red meat can be divided up and used throughout the week by mixing with vegetables in rice and pasta dishes.
Potatoes
Examples There are many varieties associated with different cooking processes.
Also Found as chips and crisps. Used in pies and processed food.
Analysis A good source of energy, fibre, B vitamins and potassium. They also contain vitamin C. They are high in starch, which is rapidly converted to glucose. Potatoes are often thought of as a vegetable, but have different properties, so are counted separately from vegetable intake.
Benefits From nutrients and fibre.
Risk in Excess High available starch content associated with increased risk of type 2 diabetes.
Sweets and Sweet Desserts
Examples Chocolates, sweets, creamy desserts, biscuits, rich cakes.
Also Processed, ‘ready-made’ desserts.
Analysis Many products are high in sugar and saturated fats and high in calories. Often low in vitamins and minerals.
Benefits Calcium content, if milk-based. Dark chocolate and cocoa contain flavonoids (anti-oxidants). Research is continuing into whether small amounts of dark chocolate can help protect against heart disease.
Risk in Excess Sweet foods damage teeth. Increased risk of heart and vascular disease, type 2 diabetes, obesity.
A tip You already knew eating too many sweet desserts and chocolates might be an unwise choice. But, perhaps these foods will be even more delicious when served as occasional treats? How about substituting fresh fruit and yoghurt?

A note on weight reduction

Research shows that peoples who adopt a strict Mediterranean diet (such as the one described below), and take regular exercise, often find this helps keep their weight under control. Mediterranean-style meals, packed with fruit, vegetables and grains can be quite filling, reducing any desire to top up with extra calories.

If this doesn’t do the trick, then you may need to reduce your energy intake and/or increase your physical activity. The recommended way to find out whether you need to lose weight is to measure your body mass index (BMI). (See separate leaflet called ‘Obesity and Overweight in Adults’.) If you’d like to take control of weight loss and still follow a varied Mediterranean Diet, then you can do this by the following.

Reducing energy intake

In the notes above, we’ve given an indication of the high-energy foods. If you go wild with oil, nuts with the nuts, or take too much alcohol or sugary drink, your body may take in more energy than it needs and store it as fat. If excess weight remains a problem, then it is worth seeing if you can reduce calorie intake levels.

Increasing exercise

It is recommended that, where possible, adults undertake daily exercise (at least 30 minutes), which can be as straightforward as taking long walks, jogging, cycling or swimming, so as to sustain a minimal level of fitness. This also helps the body to regulate weight. Body regulatory mechanisms tend to get a bit sluggish if left sitting around for too long. Any extra exercise will help to burn excess calories and fat. (See separate leaflet called ‘Weight Reduction – How to Lose Weight’.)

Reducing other health risk factors

Sticking to a Mediterranean diet and keeping active goes a long way to keeping you healthy and to reducing your risk of various serious diseases. But remember, it is part of a ‘package’ of things that you can do to keep healthy. The other main things that you can do are to not smoke, and have your blood pressure checked every 3-5 years (unless advised more often by a doctor or nurse). Oh, and if you are fortunate enough to go to the ‘Med’ to try the diet in its natural surroundings – remember to keep out of the sun as much as possible!

Adopting a strict Mediterranean diet

Scientific research has shown that the closer individuals can get to the ‘ideal’ Mediterranean Diet, outlined in the pyramid chart below, the greater the health advantage – in that, the benefit of adopting the whole dietary pattern exceeds the summated health-giving properties of its individual components.

A guide to portions or servings described in the pyramid is as follows:

  • Vegetables: a cup of raw leafy vegetables or half a cup of other vegetables.
  • Potatoes: 100 g.
  • Legumes: one cup (100 g) of cooked dry beans.
  • Nuts: 30 g. Eat as a snack or sprinkle on food for added taste.
  • Fruit: one apple, banana, one orange, 200 g of melon or watermelon, 30 g of grapes.
  • Meat: 60 g of cooked lean meat or fish.
  • Grains: half a cup (50-60 g) of cooked pasta or rice; one slice of bread (25 g).
  • Dairy:one cup of milk or yoghurt; 30 g of cheese.
  • Eggs: 1 egg.
  • Wine: 125 ml glass of average strength red wine.

In summary

The strict Mediterranean Diet has been assessed and found to contain all the essential nutrients required for normal health. But, more than this, it also prevents excesses of ingredients linked to ill health.

Mediterranean Diet – Overall
Examples The Mediterranean Diet is based on a traditional mix of foodstuffs eaten by peoples of the Eastern Mediterranean – particularly Crete and southern Italy.
Also The diet has been tested in Western industrialised countries such as the UK and USA.
Analysis High in fruit, vegetables, legumes and cereals. Fish and white meat mainly eaten in place of red meat. Mono-unsaturated oils used in place of saturated animal fats. Moderate red wine intake with meals.
Benefits Exceptional reductions in risk of early death, heart disease, cancer and chronic conditions such as hypertension, high cholesterol and type 2 diabetes. Also, reductions in Parkinson’s disease and Alzheimer’s disease risk. Adoption of the diet has proved a successful strategy for healthy weight reduction.
Risk in Excess The Mediterranean Diet maximises the intake of health-promoting ingredients, whilst minimising quantities of ingredients associated with health risks. Those adopting the Mediterranean Diet are likely to have a lower risk of disease than those who don’t.

Notes

1: In the mid-1900s, it was discovered that certain peoples of the Eastern Mediterranean (particularly Greece and southern Italy) lived longer, disease-free lives than peoples in industrialised Western countries, including the UK, even though those in the West had easy access to sophisticated health services. A key reason turned out to be differences in diet. This led researchers to analyse and successfully test an ideal diet – ‘the Mediterranean Diet’ – on Westerners.

2. From an historical perspective, many aspects of the traditional Mediterranean Diet, discussed here, were first introduced into Britain back in Roman times, when locals also ate a lot of ‘Celtic beans’. Of course, this was before Western civilisation entered its Dark Ages. So, perhaps the Mediterranean Diet should be listed as one of the things ‘the Romans did for us’?

3. It is recommended that we drink at least 6-8 glasses of non-alcoholic fluid through the day, to prevent dehydration in the temperate UK climate. More would be required in hotter weather.

4. Legumes, eg beans, feature in the Mediterranean Diet and count as one of the WHO daily fruit and vegetable portions.

5. Traditional Mediterranean folks of old considered butter to be only fit for barbarians. Toast drizzled with a little olive olive oil, herbs and garlic is still a popular Mediterranean snack.

6. Sunflower oil is often used for cooking in the UK. It is a ‘polyunsaturated fat’ that is healthier than saturated animal fats.

Try it for yourself

If you’d like to try the full Mediterranean Diet at home, we’ve translated the pyramid into this handy tick chart of food to be consumed through the week (as used by the author).

It is the author’s experience, that using the tick chart for several weeks helps to educate the eyes and palate in what to buy and cook, as well as what to avoid on restaurant menus and TV cookery programmes. So, over time, the healthy Mediterranean Diet can become a natural part of your way of life and, indeed, part of you. It’s probably the closest science can currently get to a ‘user guide’ for fuelling the human machine.

So, enjoy!

References and Disclaimer | Provide feedback

References

  • Food and diet, NHS Choices
  • The Mediterranean Diet: Constituents and Health Promotion by Antonia-Leda Matalas, Antonis Zampelas, Vassilis Stavrinos, Ira Wolinsky. Published by CRC Press, 2003. ISBN 0849301106, 9780849301100
  • Dietary Guidelines for adults in Greece. Ministry of Health and Welfare; in Archives of Hellenic Medicine 1999, 16(5): 516-524
  • Willett WC, Sacks F, Trichopoulou A, et al; Mediterranean diet pyramid: a cultural model for healthy eating. Am J Clin Nutr. 1995 Jun;61(6 Suppl):1402S-1406S. [abstract]
  • Trichopoulou A, Vasilopoulou E, Georga K; Macro- and micronutrients in a traditional Greek menu. Forum Nutr. 2005;(57):135-46. [abstract]
  • Sofi F, Cesari F, Abbate R, et al; Adherence to Mediterranean diet and health status: meta-analysis. BMJ. 2008 Sep 11;337:a1344. doi: 10.1136/bmj.a1344. [abstract]

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